The Healing of America --Meeting Presentation

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The Healing of America --Meeting Presentation

Postby Dardedar » Mon Sep 21, 2009 10:46 pm

The following is the text and notes from the health care presentation given at the Fayetteville Freethinker meeting on August 29, 2009.

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“I believe we have the best health care in the world.” --Congresswoman Bachmann

There is some truth to this. For instance if you look at certain categories of the health care the US does very well. For instance, America’s five-year survival rate for breast cancer is the best (of nine peer countries).

But do we want to sit around and pat ourselves on the back or do we want to see if we should do better?

Warning, this is going to get a little rough. If you are devoted to the idea of American Exceptionalism you might want to set that aside for a moment and approach this subject from the view of a “world citizen.” Perhaps look to the example of Thomas Paine, who put it this way:

“The world is my country, all mankind are my brethren, and to do good is my religion.”

The information in this presentation will largely be based upon a new book by T. R. Reid.

The Healing of America:
A Global Quest for Better, Cheaper, and Fairer Health Care
Amazon

He also had a Frontline episode based on some of the same information. This can be watched here

He begins by considering the example of Nikki White:

***
"Prologue: A Moral Question

“If Nikki WHite had been a resident of any other rich country, she would be alive today.

Around the time she graduated from college, Monique A. "Nikki" White contracted systemic lupus erythematosis; that's a serious disease, but on that modern medicine knows how to manage. If this bright, feisty, dazzling young woman had lived in, say Japan--the world's second-richest nation--or Germany (third richest), or Britain, France, Italy, Spain, Canada, Sweden, etc., the health care systems there would have given her the standard treatment for lupus, and she could have lived a normal life span. But Nikki White was a citizen of the world's richest country, the United States of America. Once she was sick, she couldn't get health insurance. Like tens of millions of her fellow Americans, she had too much money to qualify for health care under welfare, but too little money to pay for the drugs and doctors she needed to stay alive. She spent the last months of her life frantically writing letters and filling out forms, pleading for help. When she died, Nikki White was thirty-two years old.

"Nikki didn't die from lupus," Dr. Amylyn Crawford told me. "Nikki died from complications of the failing American health care system. It was a lack of access to health care that killed Nikki White."

--The Healing of America: The global quest for better, cheaper, and fairer health care, pg. 1


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This is the soft version of the story. He gets into the details of the surgeries she endured before her grim and senseless death.

And she’s one example.

He then cites this relevant statistic from America’s most prestigious science institute:

"a study by the National Academy of Sciences found that 20,000 Americans die each year because they can't get the health care they need."

This doesn’t happen in any other developed country. We accept avoidable deaths, pain, misery and bankruptcies, because of how we as a country answer this fundamental question…

Does a wealthy country have an ethical obligation to provide access to health care for everyone?

Every other wealthy country in the world has asked this. And every wealthy country in the world has answered: YES

We answer NO. And what has this gotten us? This brings us to:

The Paradox

• “The American medical establishment boasts many assets that no other country can match. The United States has the best-educated doctors, nurses, and medical technicians of any nation. We have the best-equipped hospitals. American laboratories lead the world in medical research; American companies set the global standard in developing miracle drugs and advanced medical technology.
But the sad fact is we’ve squandered this treasure. We’ve wasted our shining medical assets because of a health care payment system –a crazy quilt of several overlapping and often conflicting systems– that prevents millions from receiving the treatment they need and that undermines the quality of care for millions more. Three basic problems: coverage, quality, and cost.” -- pg. 29

• Of of 191 countries, the World Health Organization rated the US 54th in terms of “fairness.” Just ahead of Chad and Rwanda. --ibid, pg. 30

• Worst for medical bankruptcies (“a uniquely American problem”). --ibid pg. 31

Excerpt:

“When I was traveling the world on my quest, I asked the health ministry of each country how many citizens had declared bankruptcy in the past year because of medical bills. Generally, the officials responded to this question with a look of astonishment, as if I had asked how many flying saucers from Mars landed in the ministry’s parking lot last week. How many people go bankrupt because of medical bills/ In Britain, zero. In France, zero. In Japan, Germany, the Netherlands, Canada, Switzerland: zero. In the United Staters, according to a joint study by Harvard Law School and Harvard Medical School, the annual figure is around 700,000.” --ibid pg. 31


Many of our outcomes are mediocre by world standards:

• Of 19 countries, worst for “avoidable mortality.” --ibid pg. 31

• 19th in “Death from curable diseases.” Almost twice as high as France, Japan and Spain. --ibid pg. 32

• “Deaths Due to Surgical or Medical Mishaps” highest by far in the US. --ibid pg. 32

Life Expectancy… below most European countries --ibid pg. 33

Of 23 peer countries, in the “healthy life expectancy at age sixty,” the United States tied for last. --ibid pg. 33

A common rebuttal to the America’s poor showing in longevity is that our score is skewed by our high rates of violence and murder. The above statistic largely avoids this. wiki

COST
• The United States spent $2.2 trillion on health care in 2007, or $7,421 per person. This is 16 % of (GDP).
• France 11.1%
• Germany 10.4%
• UK 8.4%
• Canada 10.1%
• Japan 8.1%
LINK

Why are our costs so much higher:

• American doctors make a lot more money.

• US prescriptions cost 2 to 10 times as much. Same pill, made in same factory. --ibid, pg 35

• We have the highest Mal-practice costs. Mal-practice insurance in Europe can be as little as 1% of the US cost. --ibid, pg 35

• The US is the only developed country that relies on profit-making health insurance companies to pay for essential care. --ibid, pg 36

• The US is the only developed country that lets insurance companies “cherry pick” customers. --ibid, pg 36

For profit health insurance companies have medical loss ratio of about 80/20. They can’t spend more than about 80% on actual health care, or the CEO gets fired for not generating enough profit. This adds to the high administration costs.

• The US… only developed country where you lose your insurance when you lose your job. --ibid, pg. 40

• US has most complex system by far. A crazy quilt with different systems for: over 65, Military personnel, Veterans, Native Americans, Different state by state, countless payers and fee schedules. --ibid, pg 41

• For every two doctors in the US, there is one health-insurance employee, more than 470,000. In 2006, it cost almost $500 per person to administer.” --http://www.theatlantic.com/doc/200909/health-care/2

At a U.S. Senate Finance Committee meeting on Nov. 19, 2008, Dr. Reinhardt said:

“We have 900 billing clerks at Duke (medical system, 900-bed hospital). I’m not sure we have a nurse per bed, but we have a billing clerk per bed . . . it’s obscene.” --http://tinyurl.com/9fx2v7

Also consider CEO compensation:

“McGuire's exit compensation from UnitedHealth, expected to be around $1.1 billion, would be the largest golden parachute in the history of corporate America.” --wiki

Is there another country in the world that would find it acceptable to compensate one individual working in the business of healthcare, to the tune of a billion dollars?

And it’s not getting better, it's getting worse:

“Per-person health care expenditures in the United States have risen 6.5 percent per year since 2000. In contrast, consumer inflation has averaged just 2.6 percent per year.” --http://tinyurl.com/8xgfcl

Now let’s consider how some of our peer countries do it.

FRANCE

• Best performance in “Mortality Amenable to Health Care.” --The Healing of America, pg 49
• Life expectancy at age 60 = 23.3 years, (In the US = 17.9 years). --ibid, pg 49
• More doctors, more beds, same wait times, more choice. --ibid, pg 50
• Less cost: $3,165 per person vs. $7,000 in US. --ibid, pg 52
• 67% less administration. --ibid, pg 59
• Fixed prices for care are one third to one quarter of US prices. --ibid, pg 61

France has the “smart card,” the “Carte Vitale.” All health records, all billing information, all stored on an inexpensive, encrypted card (which was designed in America). Bills are paid in three days.

Excerpt:

“The expensive layer of administrative workers and paper handlers fond in every corner of American medicine doesn’t exist in France. Dr. Bonnaud told me that he and his patterns would never consider hiring a secretary or office manager. “Why would I pay somebody to do my billing?” the doctors said. “C’est automatique.” Automatic payment also makes French hospitals, public and private, dramatically cheaper to run than any U.W. hospital. Although French hospitals generally have more docters and nurses per patient than an American establishment, they have 67 percent fewer administrative personnel to keep track of paper work and billing.” Ibid, pg. 59


GERMANY

• At or near the top in all studies --The Healing of America, pg 67
• Insurance is private, prices fixed, 200 plans to choose from. --ibid, pg 67

Excerpt:

“In many areas of medical practice, there’s less government control of medical care in Germany than in the United States. It’s sheer nonsense to suggest that Germany, or any of the other countries using the Bismarck approach, is engaged in government-run “socialized medicine.” --ibid, pg 68


• They also have the digital health card. --ibid, pg 68
• Non-profit “sickness funds” have 1/3 of our administration costs.
• You don’t lose coverage with your job.
• Complete choice
• Malpractice cost to doctors can be about 1/50th of US cost. --ibid, pg 78

JAPAN

• Doc’s most competitive and capitalist in the world. --ibid, pg 83
• They love to see their doctors: 14.5 visits per year. --ibid, pg 84
• 36 day “average” hospital stay (the U.S. is 6 days) --ibid, pg 84
• Care for everyone, minimal fees, no waits, excellent results and… 8% of GDP. (1/2 of U.S. cost) --ibid, pg 85
• Costs are capped at $650 per month. You can’t pay more than that. --ibid, pg 86
• MRI of head, $105 (vs. about $1,200 in US) --ibid, pg 92
• Maternity is not covered but you receive a $3,000 maternity grant --ibid, pg 94
• Doc’s earn about 1/3 of what US Doctors do. --ibid, pg 92
• Supply exceeds demand, patients just walk in. Fee for hospital bed (not private), with food, is $11. --ibid, pg 96

United Kingdom

• Full coverage, no bills. (sales tax 16%) -ibid, pg 104
• The British National Health Service cares for 1/5 of US pop. For 1/15 of the cost. --ibid, pg 104
• Better recovery rates than the US from most major diseases. --ibid, pg 104
• Private insurance and doctors are available, but only 3% bother to use it. --ibid, pg 104
• 85% of prescriptions are free, administration costs are 1/3 of US. --ibid, pg 112
• Wait times much better --ibid, pg 114

Excerpt:

“But some people still have to wait, particularly for procedures that the NHS considers elective. In the fall of 2007, Dr. Badat told me how long his patients typically stay in the queue for specific complaints: “If you need a hernia repair, and there’s no acute pain, I think it’s about three months. Varicose veins is about six months. But if it’s acute, that’s different. We are much faster now. Any suspected cancer, seen by the consultant within two weeks. Any cardiac, we get you in the hospital the same day. If you got chest pain, I send you to cardiac within an hour.” --ibid, pg 114


CANADA

• Better health statistics at about ½ the cost. --ibid, pg 127
• National Health Care passed unanimously in 1966. Tommy Douglas, the man most responsible for creating the system was recently voted the “Greatest Canadian.” --ibid, pg 132
• Prescriptions are 50-75% less for the same pill, made in the same factory, by the same company as in the US. --ibid, pg 133
• Doctors make about ½ as much as US doctors, malpractice is tiny, all records are digital, schooling costs doctors about half. --ibid, pg 139

But is the care as good? Note:

“The most comprehensive study ever under taken on the two health care systems, the US and Canada’s, was done jointly by Harvard University and McMasters University:
“Overall, 14 of the 38 studies showed better outcomes in Canada, while only 5 favored the U.S. The remaining 19 studies showed equivalent or mixed results in the two nations. When the studies were combined statistically, the mortality rate was 5% lower in Canada.” LINK

Well then why are all those Canadians coming down here for their care? Answer: They’re not.

• "Only 90 of 18,000 respondents to the 1996 Canadian National Population Health Survey indicated they had received health care in America in the past year, and only 20 of these had gone to the U.S. specifically for that purpose.”
• Twenty people out of 18,000 represents .11 percent
• “…a recent study by the UCLA Center for Health Policy Research estimated that nearly 1 million people from California alone seek medical, dental or prescription services in Mexico each year.”
-- http://tinyurl.com/6wsk839

But what about those wait times we hear about?

Canada has had wait times for some procedures that have been too long. In 2007 Canada had a conference about this and is spending $4.5 billion to address this. This is being carefully measured and tracked by hospital. Currently:

“The median wait time in Canada to see a special physician is a little over four weeks with 89.5% waiting less than 3 months.” --LINK pdf

"The median wait time for diagnostic services such as MRI and CAT scans is two weeks with 86.4% waiting less than 3 months.” --ibid

“The median wait time for surgery is four weeks with 82.2% waiting less than 3 months.” --ibid

"In a recent survey, only 3.5 percent of Canadians reported feeling that they waited too long for care...” LINK

Are Canadian “hosers” getting hosed to pay for this health care? Their taxes must be really high!

Nope:

“The average after-tax income of Canadian workers is equal to about 82 percent of their gross pay. In the U.S., that average is 81.9 percent.” --LINK

The top income tax bracket in Canada is 29%. In the US it is 35%.

However, they do pay more for their booze and cigarettes

And having an efficient health care system really helps a countries competitiveness:

“Canadian workers are $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada…”
-- Gerry Fedchun , President of the Automotive Parts Manufacturers' Association, explaining why Toyota turned its back on hundreds of millions of dollars in subsidies offered from several American states in favour of building a second Ontario plant. -- http://www.freerepublic.com/focus/f-news/1435920/posts

Does less competition/capitalism cause stagnation in innovation? Apparently not:

"Canada has produced a disproportionately large number of major biomedical breakthroughs,..." LINK

In contrast, the US industry spends more on advertising their drugs than they do on R & D. Canada doesn't have that: there are no drug ads. According to this analysis the US spends nearly twice as much on advertising as on R & D: "Big Pharma Spends More On Advertising Than Research And Development, Study Finds" Science Daily

What do Canadians and Americans think of their respective healthcare systems?

"By an overwhelming margin, Canadians prefer the Canadian health care system to the American one. Overall, 82% said they preferred the Canadian system, fully ten times the number who said the American system is superior (8%)." --"Never mind the anecdotes: Do Canadians like their health-care system?" Chicago Tribune. http://tinyurl.com/nqvsr6

"The vast majority of Canadians, 91 per cent, felt that Canada's health care system was better than the United States..." --CTV, Jun. 29 2008, http://tinyurl.com/6ra3mwq

"Canadians strongly support the health system's public rather than for-profit private basis, and a 2009 poll... 86.2% of Canadians surveyed supported or strongly supported "public solutions to make our public health care stronger." http://www.healthzone.ca/health/article/679824

American responses:

"...extensive ABCNEWS/Washington Post poll, Americans by a 2-1 margin, 62-32 percent, prefer a universal health insurance program over the current employer-based system." -- http://tinyurl.com/72wnl

"...just 29 percent of Americans think the overall U.S. health care system is better than Canada's; more, 37 percent, think it's worse than Canada's." --ibid

"Harris Interactive polling..., found that 45 percent of Americans thought the U.S. medical system generally was the best. The remaining 54 percent either didn't know or thought other countries' systems were better..." --Bloomberg, "Americans Say Health Care Lags Canada, France in Harvard Poll" http://tinyurl.com/7av9wlg

In conclusion, it's also important to note what T.R. Reid calls the: Universal Laws of Health Care Systems:

1. No matter how good the health care in a particular country, people will complain about it.
2. No matter how much money is spent on health care, the doctors and hospitals will argue that it is not enough.
3. The last reform always failed.

Some of the common lies being spread about health care debunked here.

Bonus info to consider:

The Veterans Administration
The VA is “one of the world’s purest models of socialized medicine at work.” Yet, the government-run U.S. Veterans healthcare system is now considered significantly more efficient at providing quality care than private-sector healthcare:
• The New England Journal of Medicine ("Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care, May 29, 2003)
• The Annals of Internal Medicine ("Diabetes Care Quality in the Veterans Affairs Health Care System and Commercial Managed Care: The TRIAD Study," August 17, 2004)
• U.S. News & World Report (America's Best Hospitals, Military Might, July 18 2005);
• The American Journal of Managed Care ("The Veterans Health Administration: Quality, Value, Accountability, and Information as Transforming Strategies for Patient-Centered Care," 2004,10; part2);
• Washington Monthly ("The Best Care Anywhere," January/February 2005)
• The Washington Post ("Revamped Veterans Health Care Now a Model," August 22, 2005).

More data on the VA:

"Overall, VHA patients received better care than patients in other settings." LINK

"The quality of care in the VA health care system substantially improved after the implementation of a system wide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program." New England Journal of Medicine

"The findings mark the sixth consecutive year the VA health care system has outranked the private sector for customer satisfaction." Washington Post

"Improving Quality of Care
How the VA Outpaces Other Systems in Delivering Patient Care" Rand study

"How do VA costs compare to the cost of non-VA providers?" DAV

Also: 'Socialized' or Not, We Can Learn from the VA
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Mon Dec 28, 2009 4:33 pm

An interesting chart I may need later:

Image
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Re: The Healing of America --Meeting Presentation

Postby Betsy » Mon Dec 28, 2009 5:14 pm

where did you get this chart?
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Mon Dec 28, 2009 6:16 pm

In the comment thread of this Firedoglake blog, third comment down.

That's it.
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Sun Mar 21, 2010 7:09 pm

I will be giving a shorter and improved/refined presentation of the above mentioned healthcare presentation on Monday. I have gone through and made sure I had references for all of my claims. The following is a handout that will be available to the audience. I thought it would be useful to post a copy here:

***
Let’s talk about Health Care

The Healing of America:
A Global Quest for Better, Cheaper, and Fairer Health Care… By T. R. Reid (all page references refer to this book)

“America’s five-year survival rate for breast cancer is the best.” http://tinyurl.com/yfxwl6x

Sick Around the World video: http://tinyurl.com/yzhukps

“20,000 Americans die each year.” --pg. 2 (ref: National Academy of Sciences) see also: http://tinyurl.com/yz5pe66

• Of of 191 countries, the World Health Organization rated the US 54th in terms of “fairness.” Just ahead of Chad and Rwanda. The Healing of America, pg. 30
• Worst for bankruptcies. --ibid pg. 31
• Of 19 countries, worst for “avoidable mortality.” --ibid pg. 31
• 19th in “Death from curable diseases.” Almost twice as high as France, Japan and Spain. --ibid pg. 32
• “Deaths Due to Surgical or Medical Mishaps” highest by far in the US. --ibid pg. 32
• Of 23 peer countries, in the “healthy life expectancy at age sixty,” the United States tied for last. --ibid pg. 33
• The United States spent $2.2 trillion on health care in 2009, or $8,047 per person. This is 17.3 % of (GDP). -- http://tinyurl.com/yz6kxko
• Other countries see: http://csis.org/blog/oecd-figures-health-care-gdp

COST
• US prescriptions cost 2 to 10 times as much. --ibid, pg 35
• Mal-practice insurance in Europe can be 1% of US cost. --ibid, pg 35
• The US is the only developed country that relies on profit-making health insurance companies to pay for essential care. --ibid, pg 36
• For every two doctors in the US, there is one health-insurance employee, more than 470,000. This costs… almost $500 per person to administer.” --http://www.theatlantic.com/doc/200909/health-care/2
• We pay 18x as much as France for an appendectomy-- [link is PDF] …http://tinyurl.com/knkvqa

• We have 900 billing clerks at Duke (900-bed hospital). -- http://tinyurl.com/9fx2v7

• McGuire, CEO United Healthcare, $1.6 billion payoff --http://en.wikipedia.org/wiki/William_W._McGuire

FRANCE
• Best performance in “Mortality Amenable to Health Care.” --The Healing of America, pg 49
• More doctors, more beds, same wait times, more choice. --ibid, pg 50
• Less cost: $3,165 per person vs. $7,000 in US. --ibid, pg 52
• 67% less administration. --ibid, pg 59
• Fixed prices for care are one third to one quarter of US prices. --ibid, pg 61

GERMANY
• At or near the top in all studies --The Healing of America, pg 67
• Insurance is private, prices fixed, 200 plans. --ibid, pg 67
• They have the digital health card. --ibid, pg 68
• 1/3 of our administration costs. Malpractice about 1/50th of US cost. --ibid, pg 78

JAPAN
• Doc’s most competitive and capitalist in the world. --ibid, pg 83
• Care for everyone, minimal fees, no waits, excellent results and… 8% of GDP. (1/2 of U.S.) --ibid, pg 85
• Costs are capped at $650 per month. --ibid, pg 86
• Fee for hospital bed, with food… $11. --ibid, pg 96

CANADA
• Better health statistics at about ½ the cost. --ibid, pg 127
• National Health Care passed unanimously in 1966. Tommy Douglas, voted greatest Canadian. --ibid, pg 132
• RX = ¼ to ½ cost for same pill, same company. --ibid, pg 133
• Doctors make about ½, malpractice is tiny, all records digital, Doc schooling cost about half. --ibid, pg 139
• 90% of Canadians support universal, single-payer health care. -- http://medicare.ca/wp-content/uploads/2 ... s-poll.pdf

• The most comprehensive study of US/Canada systems… Overall, 14 of the 38 studies showed better outcomes in Canada, while only 5 favored the U.S.” --http://tinyurl.com/yjaqe9s

“Run for the Border” myth
"Only 90 of 18,000 [Canadians surveyed] had received health care in America in the past year, and only 20 [.11%] of these had gone to the U.S. specifically for that purpose.” --http://tinyurl.com/lh6t4g

Regarding Wait Times…
• “The median wait time in Canada…” see: --http://www.healthcoalition.ca/index-eng.pdf
• Harvard study found waiting times “affect 3.5 percent of Canadians versus 0.7 percent of people in the U.S." --http://www.commondreams.org/headlines06/0531-04.htm
• “Canadians pay about the same in income taxes” --http://www.denverpost.com/recommended/ci_12523427
• “Canadian workers are $4 to $5 cheaper to employ partly thanks to the taxpayer-funded health-care system in Canada…” -- http://tinyurl.com/llafm6
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Tue Jun 22, 2010 7:46 pm

Health Care Reform Media Coverage Was Terrible, Finds New Study

Hey, everyone! Did the rampant coverage of the health care reform debate leave you utterly beside yourself with confusion and under the strong impression that most of the coverage focused on the political horserace crap rather than a studious explanation of how reform was going to impact your life? Well, you're not alone -- that's exactly how the media covered the matter, because they are terrible.

A new study by Pew Research, in which the organization undertook a "comprehensive study of more than 5,500 health care stories in the mainstream media from June 2009 through March 2010" tells the sorry tale. Between June of 2009 and March of 2010, health care reform dominated the "newshole." During that time, the story proved to be catnip for "ideological talk shows." Says Pew, "the subject was more than twice as big in the talk show sector as it was in the overall media."

...here's the big takeaway:

"The debate centered more on politics than the workings of the health care system. Fully 41% of health care coverage focused on the tactics and strategy of the debate while various reform proposals filled another 23%. But only 9% of the coverage focused on a core issue -- how our health care system currently functions, what works and what doesn't."


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The above graph tells the the sorry story of the misshapen ratio of coverage, in which more than twice the amount of time devoted to actually explaining the various plans was instead given over to "politics and strategy" and the "legislative process." Coverage of the latter category was mostly marked by ordinarily rational people screeching like hyenas about how radical the budget reconciliation process was, when it is actually quite ordinary. It also featured people proving hysterically wrong about very basic matters, such as Chris Matthews in a howlingly ignorant segment he conducted with Representative Alan Grayson (D-Fla.).

Of course, it should be no surprise that the coverage was dominated by talk of strategy and "who's up, who's down" and polls and wild-eyed speculation on the shape of future electoral fates, because this is all your political media care about. Actually explaining what a health care plan does would require an attention span and a dedication to something other than simpleminded goofery. And it's also no surprise that "state of health care" ranked so low -- to actually know something about the "state of health care," cable news would have to be aware of the existence of people who aren't well-compensated media professionals.

Elsewhere, Pew found that despite the fact that "liberal talk show hosts devoted more airtime to health care than conservative hosts," the opposition to health care reform nevertheless "won the message war." This was accomplished through a very complicated and nearly inscrutable strategy called "lying."

Huff Po
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Fri Jun 25, 2010 7:49 pm

"As a new Commonwealth Fund study reveals,...The United States' health care system is still the worst among industrialized nations. And, as it turns out, its performance is most pitiful where Republicans poll best."

Overpriced, Underperforming U.S Health Care System Lags Competitors

Back in 2000, the U.S ranked a dismal 37th in an eye-opening if controversial World Health Organization assessment of global health care. Then in 2003, a Commonwealth Fund report revealed America ranked last across virtually every category of health care cost, access, efficiency, quality and lifestyles compared to Australia, Britain, Canada, Germany and New Zealand. Three years later in 2006, another Commonwealth Fund study ("U.S. Health System performance: A National Scorecard") of 19 industrialized nations ranked the U.S. 19th in infant mortality, 15th in preventable mortality and 14th in the use of electronic medical records, all despite spending far and away the greatest percentage of GDP on health care. Relative to other comparable countries surveyed, the U.S. has the greatest incidence of medical and prescription errors, highest emergency room waiting times and ranks near the bottom in duplicate medical tests. The U.S. spends 7.3% of its health dollars on administration and insurance, compared to just 1.9% in France, 2.6% in Canada, and 3.3% in the UK.

Now, in "Mirror, Mirror on the Wall: How the Performance of the U.S. Health Care System Compares Internationally, 2010 Update," the latest Commonwealth Fund assessment finds little has changed:

Among the seven nations studied--Australia, Canada, Germany, the Netherlands, New Zealand, the United Kingdom, and the United States--the U.S. ranks last overall, as it did in the 2007, 2006, and 2004 editions of Mirror, Mirror. Most troubling, the U.S. fails to achieve better health outcomes than the other countries, and as shown in the earlier editions, the U.S. is last on dimensions of access, patient safety, coordination, efficiency, and equity. The Netherlands ranks first, followed closely by the U.K. and Australia. The 2010 edition includes data from the seven countries and incorporates patients' and physicians' survey results on care experiences and ratings on various dimensions of care..

The most notable way the U.S. differs from other countries is the absence of universal health insurance coverage. Health reform legislation recently signed into law by President Barack Obama should begin to improve the affordability of insurance and access to care when fully implemented in 2014. Other nations ensure the accessibility of care through universal health insurance systems and through better ties between patients and the physician practices that serve as their long-term "medical homes." Without reform, it is not surprising that the U.S. currently underperforms relative to other countries on measures of access to care and equity in health care between populations with above-average and below-average incomes.


Image

The table above (and the accompanying Commonwealth Fund chart pack and interactive comparison) summarizes an the critical condition of the grotesquely expensive and shockingly underperforming American health care system.

While not highlighted in this report, the Commonwealth Fund has detailed elsewhere the tremendous disparity in health care performance within the United States. Unsurprisingly, health care is worst in those reddest of red states, especially in the South.

The diagnosis isn't pretty for Republicans committed to denying the health care their constituents need most of all. A 2009 UnitedHealth study looked at "22 indicators of health, including everything from how many children receive recommended vaccinations, to obesity and smoking rates, to cancer deaths" and similarly found that nine of the top 10 healthiest states voted for Barack Obama in 2008. Conversely, 9 of the 10 cellar dwellers backed John McCain in 2008; four years earlier, the 15 unhealthiest states all voted for George W. Bush for President."

PERRspectives
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Mon Sep 20, 2010 10:44 pm

Some Grey Bloke on British healthcare

Video clip, 22 seconds well spent.
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Fri Oct 08, 2010 8:04 pm

The US healthcare system is to blame for declines in the country's life expectancy ranking, a study suggests.

The Columbia University report rejects claims that factors such as obesity have shortened life-spans for Americans relative to other wealthy nations.

The study blames reliance on costly and fragmented specialised care, and calls for systemic reform.

Its release comes as President Barack Obama's healthcare reform remains a key issue in upcoming mid-term elections.

Higher costs

The study notes that in 1950, the US ranked fifth among leading industrialised nations for female life expectancy at birth, but only 46th in 2008.

It finds that US healthcare spending increased at nearly twice the rate of that in other wealthy nations between 1970 and 2002, with the increased spending corresponding with worsening survival rates relative to the other countries studied.

"In most cases, the relative US performance deteriorated from decade to decade," wrote authors Peter Muennig and Sherry Glied of Columbia University's Mailman School of Public Health.

They note the countries to which the US is compared - Australia, Austria, Belgium, Canada, France, Germany, Italy, Japan, the Netherlands, Sweden, Switzerland and the UK - all provide universal healthcare coverage.

Factors such as differing obesity, smoking, road accident and murder rates were taken into account in the study.

'Meaningful reform'

The US spends far more on healthcare than any other country as a percentage of gross domestic product, the study finds.

"We speculate that the nature of our health care system - specifically, its reliance on unregulated fee-for-service and specialty care - may explain both the increased spending and the relative deterioration in survival that we observed," the authors wrote.

"If so, meaningful reform may not only save money over the long term, it may also save lives."

The authors said those aspects of the US health system contributed to unnecessary medical procedures, poor communication between doctors and higher rates of medical errors.

LINK

Note, on longevity:

"...the United States has below-average life
expectancy (Figure 24) and mortality rates (Table 5). The United States has the
third-highest rate of deaths from medical errors (Figure 25) and the highest infant
mortality rate among the eight countries that report this metric similarly (Figure 26)." -pg. 65
--http://assets.opencrs.com/rpts/RL34175_20070917.pdf
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Thu Nov 18, 2010 9:50 pm

A very intelligent post in a comment thread on Huff Po. Sad but true.

I don't want to rain on anyone's parade, but I'm an HR 676 ("Expanded and Improved Medicare For All") supporter, and I think PPACA is just about the worst possible solution that can still be technically qualified as reform. It basically institutionalizes and subsidizes the wasteful, parasitic, fragmented non-system we already have.

Every other First World country has a single bargaining agent to negotiate uniform medical prices -- drugs, tests, operations, ambulance rides, MRIs, doctor visits, etc. -- in advance, on behalf of patients. They all have radically more efficient, harmonized or centralized administration. None of them uses for-profit insurance for essential health care (with a few exceptions for the wealthy). We have done none of this and will continue to have by far the most expensive, least efficient, least protective, least universal health insurance system in the developed world.

Yes, if the GAO's predictions pan out, the budget deficit may be eased somewhat. But that's because taxes and patient out-of-pockets ("co-insurance") will go up. The percentage of GDP we devote to health care -- already by far the highest in the world, even though we have between 50 and 59 million uninsured and see doctors far less often than our peers -- will go *up* even more than if we did nothing. That's why stock in insurance and pharmaceutical companies went up. Ka-ching!

I'm happy for the modest improvements PPACA brings, but what a wasted opportunity! Medicare For All would have been simpler, cheaper, and better. LINK
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Tue Nov 30, 2010 11:06 am

How Health Insurance Design Affects Access to Care and Costs, by Income, in Eleven Countries

A new 11-country survey from The Commonwealth Fund finds that adults in the United States are far more likely than those in 10 other industrialized nations to go without health care because of costs, have trouble paying medical bills, encounter high medical bills even when insured, and have disputes with their insurers or discover insurance wouldn’t pay as they expected.

The U.S. stands out for the most negative insurance-related experiences.

One third (33%) of U.S. adults went without recommended care, did not see a doctor when sick, or failed to fill prescriptions because of costs, compared to as few as 5 percent to 6 percent in the Netherlands and the U.K., according to the study.

One-fifth of U.S. adults had major problems paying medical bills, compared to 9 percent in France, the next highest country, 2 percent in the U.K., 3 percent in Germany, and 4 percent in the Netherlands."

Commonwealth Fund
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Re: The Healing of America --Meeting Presentation

Postby L.Wood » Fri Dec 17, 2010 5:32 pm

.
Hat Tip to Louise Montgomery for this:

"When Social Security was passed, there were all kinds of lawsuits," just as there have been in the legal battle over the new health care law.
Barack Obama on Monday, December 13th, 2010 in a television interview"

Barack Obama compares legal battle over health care to 1930s fight over Social Security
Historic Court Challenges to Federal programs.

This article provides a good, thorough discussion
From St Petersburg Times, PolitiFact.com

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Re: The Healing of America --Meeting Presentation

Postby L.Wood » Sat Jan 22, 2011 6:05 pm

.
Congress Passes Socialized Medicine and Mandates Health Insurance -In 1798

The ink was barely dry on the PPACA when the first of many lawsuits to block the mandated health insurance provisions of the law was filed in a Florida District Court.

The pleadings, in part, read -

The Constitution nowhere authorizes the United States to mandate, either directly or under threat of penalty, that all citizens and legal residents have qualifying health care coverage.

State of Florida, et al. vs. HHS

It turns out, the Founding Fathers would beg to disagree.

In July of 1798, Congress passed – and President John Adams signed - “An Act for the Relief of Sick and Disabled Seamen.” The law authorized the creation of a government operated marine hospital service and mandated that privately employed sailors be required to purchase health care insurance.

Keep in mind that the 5th Congress did not really need to struggle over the intentions of the drafters of the Constitutions in creating this Act as many of its members were the drafters of the Constitution.

And when the Bill came to the desk of President John Adams for signature, I think it’s safe to assume that the man in that chair had a pretty good grasp on what the framers had in mind.

Here’s how it happened.

During the early years of our union, the nation’s leaders realized that foreign trade would be essential to the young country’s ability to create a viable economy. To make it work, they relied on the nation’s private merchant ships – and the sailors that made them go – to be the instruments of this trade.

The problem was that a merchant mariner’s job was a difficult and dangerous undertaking in those days. Sailors were constantly hurting themselves, picking up weird tropical diseases, etc.

The troublesome reductions in manpower caused by back strains, twisted ankles and strange diseases often left a ship’s captain without enough sailors to get underway – a problem both bad for business and a strain on the nation’s economy.

definitely worth a read...link
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Mon Jan 31, 2011 8:58 pm

--Massachu­­setts Individual Market single coverage 2006-2007: .... $8,537

LINK

--Massachu­­setts Individual Market single coverage 2009: ..........­­...$5,143

LINK

That is a 40% DECREASE in annual premium from 2006 to 2009. Nationally­, annual premiums in these same markets have INCREASED by 14%.

Also, the uninsuranc­e rate in Massachuse­tts is 1.9%, while nationally the uninsured rate is 17%. The child uninsured rate in Massachuse­tts is 0.2%, while nationally­, the uninsured rate among children is 10%. Pathetical­ly, such an effective plan is tra/shed by Republican­s."

Huff Po
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Wed Jun 08, 2011 9:35 am

Image
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Sun Jun 19, 2011 12:26 am

Excellent debunk. Passed along from Larry W.

***
Meme-busting: Doctors are abandoning Canada in great numbers to work here
June 16, 2011, Aaron Carroll

This is an ongoing series on health care system “memes” that continue to permeate our debate, even when evidence shows them to be false. The introductory post contains links to all entries.

Every time I talk about health care policy with physicians, one inevitably tells me of the doctor he or she knows who ran away from Canada to practice in the United States. Evidently, there’s a general perception that practicing in the United States is much more satisfying than in countries such as Canada.

If only that were so.

Image

Except for Austria and Germany, fewer doctors were satisfied practicing medicine in the United States in 2009 than in any other surveyed country. That includes Canada. And it was before health care reform, so you can’t blame any dissatisfaction on the PPACA.

They also asked physicians what they thought about the health care system (again this was before the PPACA):

Except for Germany, more physicians in the United Sates felt that the system needed to be completely rebuilt than physicians in any other country. The United States tied with Germany for last with an overwhelming 82% of physicians who thought the system needed fundamental changes or to be completely rebuilt.

So let’s stop pretending that doctors in outer countries are miserable, and practicing in the Unites States is paradise.

But the main outcome of interest here is doctors emigrating from Canada. The meme is that physicians are leaving Canada in droves and moving here. Is that true?"

-----
The answer, and the rest, here:

The Incidental Economist
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Mon Jun 20, 2011 10:46 pm

James Verone Robs Bank For Jail Health Care

James Verone said he walked up to a teller at a Gastonia, N.C. bank and handed her a note.

It said "This is a bank robbery, please only give me one dollar." Verone then told the teller he'd be sitting in a nearby chair, waiting for the police.

The 59-year-old said he did everything he could to get caught so he could receive free health care in jail.

Verone has a growth on his chest, two ruptured disks and a problem with his left foot. With no job, Verone thought his desperate plan was the best way to provide for himself.

Verone was charged with larceny.

Courtney Boyd Myers at The Next Web notes Verone's plot provides clear evidence of a flawed medical system.

"As his fellow American, I have to say, our national health care is in a very sad state," Myers writes.

Huff Po
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Tue Jun 21, 2011 2:19 pm

Meme-busting: Canadians regularly come to the US for care

Also:

Meme-busting: Doctors are abandoning Canada in great numbers to work here

And now:

Meme-busting: Tort reform cost control

Excerpt:
----------------
Meme-busting: Tort reform = cost control
June 13, 2011
Aaron Carroll

This is an ongoing series on health care system “memes” that continue to permeate our debate, even when evidence shows them to be false. The introductory post contains links to all entries.

For better or for worse, whenever many are asked about how they would help control the cost of the health-care system, tort reform always seems to be one of the first things offered as a solution.

The argument goes that doctors, afraid of being sued, order lots of extra tests and procedures to protect themselves. This is known as defensive medicine. Tort reform assumes that if we put a cap on the damages plaintiffs can win, then filing cases will be less attractive, fewer claims will be made, insurance companies will save money, malpractice premiums will come down, doctors will feel safer and will practice less defensive medicine, and health-care spending will go way down.

Ergo, tort reform = cost control.
......
Cutting to the chase: Does tort reform lower medical costs? You get three guesses and the first two don't count but it lowers costs IF you think that
"health-care spending reduction of 0.1 percent" is significant. That's one tenth of one per cent."

More roast of Tort Reform: New Paper Debunks Malpractice Myths
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Re: The Healing of America --Meeting Presentation

Postby Dardedar » Fri Jul 01, 2011 12:31 am

"...private insurance simply costs more. As Paul Krugman lamented in reviewing the Coburn-Lieberman proposal:

The idea of Medicare as a money-saving program may seem hard to grasp. After all, hasn’t Medicare spending risen dramatically over time? Yes, it has: adjusting for overall inflation, Medicare spending per beneficiary rose more than 400 percent from 1969 to 2009.

But inflation-adjusted premiums on private health insurance rose more than 700 percent over the same period. So while it’s true that Medicare has done an inadequate job of controlling costs, the private sector has done much worse. And if we deny Medicare to 65- and 66-year-olds, we’ll be forcing them to get private insurance — if they can — that will cost much more than it would have cost to provide the same coverage through Medicare.


http://www.nytimes.com/2011/06/13/opini ... .html?_r=3

Via: Crooks and Liars
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